Original Contribution
The American Journal of Gastroenterology (2005) 100, 1002–1008; doi:10.1111/j.1572-0241.2005.41007.x
Fundoplication and the Risk of Esophageal Cancer in Gastroesophageal Reflux Disease: A Veterans Affairs Cohort Study
Thomas Tran MD1, Stuart J Spechler MD1, Peter Richardson PhD1 and Hashem B El-Serag MD, MPH1
1Department of Medicine, Baylor College of Medicine, Houston, Texas; Division of Gastroenterology, Dallas Veterans Affairs Medical Center, Texas; the Sections of Health Services Research at the Houston Department of Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas; and the Sections of Gastroenterology and Health Services Research at the Houston Department of Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas
Correspondence: Hashem B. El-Serag, MD, MPH, The Houston Veterans Affairs Medical Center (152), 2002 Holcombe Blvd., Houston, TX 77030
Received 19 June 2004; Revised 0000; Accepted 29 October 2004.
Abstract
BACKGROUND AND AIMS:
It has been proposed that fundoplication can reduce the risk of esophageal cancer in patients with gastroesophageal reflux disease (GERD). In this cohort study, we assessed the effect of fundoplication on the incidence of esophageal cancer.
METHODS:
We identified all Veterans Affairs (VA) patients with GERD who had fundoplication between 1986 and 1990 and matched (1–2) to controls with GERD and no fundoplication and to controls with no GERD. We calculated incidence rates for esophageal cancer through October 2002 and examined the effect of fundoplication on the risk of esophageal cancer using Kaplan-Meier survival analysis and Cox proportional hazard analysis. We calculated and adjusted for the propensity score for receiving fundoplication.
RESULTS:
We identified 946 patients who had fundoplication, 1,892 patients who had GERD without fundoplication, and 5,676 patients with no GERD. The mean age was 55 yr and 97.5% were men in all three groups. During a follow-up of 11,156 patient-years (PY), there were eight cases of esophageal cancer (72/100,000) in the fundoplication group. During a follow-up of 20,115 PY, there were eight cases of esophageal cancer (40/100,000) in the GERD without fundoplication group. During a follow-up of 59,439 PY, no patients in the group with no GERD developed esophageal cancer. The Kaplan-Meier analysis showed no significant difference in cumulative esophageal cancer rates between the fundoplication group and the GERD no-fundoplication group. The adjusted hazard ratio of esophageal cancer with fundoplication was 1.88 (95% CI: 0.70–5.03).
CONCLUSIONS:
GERD is a risk factor for esophageal cancer, but there is insufficient evidence that fundoplication reduces that risk.
